The First Step
by schmerzerling
Summary: Dean goes through detox, but he misses an important step in the whole "getting clean" process.


Originally posted anonymously for this prompt over at the Hoodie Time H/C comm on LJ:

_Dean somehow lands into the alcohol detox ward of a hospital somewhere. Maybe he goes willingly or Sam forces him, whatever. In any case, it takes a long time and is a brutal ordeal but he's eventually released into Sam's care. However, due to the harshness of the drugs and various treatments and just the detox/withdrawal itself, Dean lost a ton of weight. I don't want abuse or mistreatment from the staff - instead they were phenomenal and did all they could and more... it's just the result of the whole ordeal and the rewriting of his own body chemistry - think insomina, puking his guts out, having no appetite, constipation/diarrhea, the sweats, the shakes, the works - and just being in the hospital with crappy food._

_In any case, Dean is finally clean and he's painfully thin, all jutting hips and ribs and he's constantly freezing since he can't conserve any body heat, huddled up in Sam's hoodie, all their blankets, the heater on full blast and still shivering. Sam's great, putting up with the sahara that is their new home for the time being (they can be squatting, in a nicer motel for once, or just permanently settled down) and he plys Dean with smoothies and other fortifying drinks and some of his brother's favorite food... etc. And it helps and Dean slowly gains the weight back, ounce by ounce._

_Bonus points if still has mild, ongoing withdrawal effects - according to Saint Wikipedia, alcohol withdrawal symptoms can continue for up to a year after quitting - and Sam helping Dean through the insomnia and nausea/vomiting and cravings._

Fic is a little off topic, but it deals with the show's inability or unwillingness to confront and name the characters' alcoholism. I get the feeling that even if Dean was forced to detox, he would kind of miss the point. Had a bit too much fun with the symptoms here, and the timeline is VERY ambiguously seven/eight. Uh. Sometime.

Contains alcohol abuse, seizures, depression, weight loss. Upset Dean.

Enjoy!

* * *

The fronts of the pamphlets that the doctor gives him mostly have people with their heads in their hands, sad and upset and looking at the ground. They all look kind of disappointed in themselves. One of the pamphlets has a bald man smiling and rejecting a beer that another man is thrusting in his direction. All of these men look healthy. All of these men are clearly not afflicted with the thing they are advertising, because none of them look _sick_.

"Dean here had a bit of a reaction to the diazepam. Didn't you, Dean?"

Dean's sitting in a wheelchair, blanket tucked in over his legs, looking tired and, hell, a lot worse than when Sam had dropped him off several weeks ago. He's got a line of stitches right at his hairline – neat, orderly hospital stitches, not the haphazard lines of dental floss that Sam is wont to make. And he's _skinny_. He'd been losing weight hard and fast before they got Dean into detox, but Sam figured that was mostly because of his liquid diet.

Dean hates being condescended to. He doesn't respond to the doctor's prompting, and based on the way the doctor just grasps his shoulder for a second and glosses over it, he's probably pretty used to it.

Sam learns that pretty much everything that could have gone wrong with Dean's treatment _did_ go wrong. The diazepam induced seizures or aggravated the seizures, Sam's a little unclear, and it's supposed to do the exact _opposite_, apparently, so they didn't expect it, and that explained stitches because he'd apparently nearly seized himself right into brain damage. He hadn't been able to keep anything in his stomach. He'd vomited, he'd lost his appetite.

"I shit the bed," Dean says, deadpan. It's the first thing he's said to Sam since he arrived, and the doctor nods, looking pained.

"A little incontinence is to be expected, Mr. Roth. Nothing to be ashamed of."

They give Sam prescriptions to be passed along to the rehab clinic. Anticonvusants. Antiemetics. _Antidepressants_. Vitamins, vitamins, vitamins. It's all insanely overwhelming. And as his brother is standing on shaky legs at the curb, climbing unsteadily into the passenger side of the Impala, a nurse puts a hand on Sam's arm and says, "And you have to keep the poor thing_ warm_, son." Sam just nods, dazed.

* * *

Dean's condition to entering detox had been that _Sam couldn't watch._ Sam couldn't visit. Sam didn't need to see. Sam could find a hunt somewhere on the east coast, leave Dean in the passable clinic they'd found in Maine, and just let it be. And then when Sam came to pick him up, they wouldn't talk about it and Dean wouldn't drink anymore and that would be _it_.

When Dean had helped Sam to detox from the demon blood, he'd always given him some degree of privacy. Sam knows that was at least partly selfish, knows that Dean couldn't really bear to hear Sam screaming his lungs out and flipping around the room, but he knows it was also so that Sam could maintain some degree, some illusion, of self-respect. Dean had passed the point where they would be able to just lock him in a room and let this all blow over, though, so that wasn't really an option. They had learned as much the hard way, because they'd tried, and his brother had gone tachycardic and started having hellish hallucinations. That was how they'd found the detox ward in the first place. He needed drugs to ease him through, they'd told them, or it was very possible that he could die. And what a stupid, _stupid_ reason for the Righteous Man to go.

So Sam had done as he was told. He dropped him off, and now he was picking him up, and he was supposed to be taking Dean to a nice, warm rehab clinic a little ways from the hospital where he had detoxed, but Dean had just said, "Fuck that," turned the heat in the Impala all the way up, blasted his music, and told Sam to _drive_.

Sam does. Dean passes out about an hour after they've put the hospital in their rearview mirror, but he still looks exhausted, and he's breathing heavy, even in his sleep. He'd taken the blanket from his wheelchair, and it's still on his lap now. His hands are curled up underneath it. Sam repositions the blast of dry air from the vent that had been hitting him right in the face just as a trickle of sweat reaches the collar of his shirt.

He feels so ill-equipped to deal with all this, and he knows that he's supposed to get the prescriptions filled as soon as he can because Dean's going to be experiencing "mild withdrawal symptoms" even still and he's going to be having a hell of a time with it, but he can't get the image of Dean in that wheelchair out of his head, scrunched up and tiny, and he decides he needs to feed him.

He pulls over at a diner and gets out to make sure they don't serve alcohol before he goes back to the car to wake his brother and help him in. They sit at a red vinyl booth in a dark corner, right by a window where they can see that snow has started to fall outside. Sam regrets the window decision when Dean immediately starts shivering.

The waitress is older, eyes wrinkling at the corners. She calls Sam "hon" and Dean "sugar," and she plies them both with a free round of creamy hot chocolate because, she says, "You boys look like you need to warm your bones." Sam thinks that she's doing it because Dean's gauntness is _scaring_ her, just like it's scaring him, because he can't imagine anyone looking at Dean now and thinking that he may be even slightly okay.

Dean just breathes the steam from the hot chocolate and puts his hands on the mug to warm them. His fingers are bony.

"Did they starve you in there, or what?" Sam blurts without meaning to. "Jesus, Dean. Your paperwork says you've lost like fifty pounds." That's not true. The paperwork says Dean weighs around 120 pounds. Sam knows that he weighed something like 175 at his healthiest, though he'd been fluctuating like crazy ever since Hell. When he'd checked in to detox, he'd probably weighed around 150. It wasn't all their fault, Sam shoulders most of the blame himself, he knows. But god, it's hard to not want to go in there and make them answer for what his brother seems to have become overnight.

Dean laughs throatily. "Naw. They were good t'me. Put up with a lot of shit. My skinny ass is on me." As if to accentuate the point, Dean looks helplessly at the hot chocolate in his hands, like he can't even fathom taking a drink.

And Sam thinks, no. You're wrong. Me, it's on me.

He orders Dean a cheeseburger, and their nice waitress ends up boxing up the whole thing.

* * *

When Dean had been in the hospital, Sam had been called just once. He'd seen the Maine area code on his phone, and he'd been jolted from a strange sort of state he'd entered. He'd felt disconnected, detached. He'd felt like he had when Dean had been in Hell, or when the trickster had given him a taste of how it would be when he finally was. He'd felt alone, guilty, driven. Completely wrapped in his hunt. Bad, bad, bad.

He'd answered half-expecting his brother to be dead, but the call had been from a counselor.

"Sam Roth?" she'd said. "We just want you to know that your brother is doing alright, and he'll be ready to be transferred to a rehab facility in a few days."

"That's…that's good," Sam had said. It had been early morning, and he'd been standing in a cemetery, leaning on a shovel planted in the dirt of a grave. He'd been losing himself in the pleasant exhaustion of well-worked muscles, and his brother had forcibly been the furthest thing from his mind. "Really good."

"We notice you haven't inquired about visiting hours, and we were wondering if perhaps you would benefit from some personal counseling? Sometimes it can be hard to watch a loved one endure something like this, and your brother gave us the impression that you are otherwise very close."

Sam had almost _laughed_, because Dean always teased him about needing to talk about his feelings, about always looking for excuse to be touchy-feely, but he hadn't even been able to find the words for how ridiculous this whole situation was.

He wonders now if they had offered Dean the same service. Of course they had – they dealt with these patients all the time, they probably had someone in-house to go around and try to suss a heartfelt apology out of all the vulnerable, detoxing patients. And yeah, a lot of the problem was Dean's mental state, he got that, he got that maybe detoxing him and sending him cold turkey back into the same cruel world maybe wasn't the greatest idea, but this is just the best they can do. He wishes it isn't, but it just _is_.

So he'd said the only thing he could say.

"No. No. I'm fine. Really."

* * *

He quickly finds that Dean being cold isn't just a fresh-out-of-the-hospital thing. Dean being cold is an all the time, non-stop, fulltime job kind of thing. In the winter in the northeast, all his energy seems to be consumed with dealing with it, and it probably has something to do with the fact that he needs to put on about thirty pounds to be just the right side of unhealthy, but he can't stomach much of anything, and Sam seems to have lost his touch with getting Dean to do what Sam needs him to do. Or maybe he just never even had it in the first place.

They're heading steadily south, and Sam says it's because there's a hunt down there, but really the only thing on his mind is _warm_. If he can get Dean to a better climate, maybe Dean will stop half-jokingly asking for a flask to warm him up, and maybe he'll stop shivering every time his ass touches the leather of the front seat, and maybe he'll want to get up and _move _in the morning rather than stay holed up under the stained hotel comforters they've been accumulating.

Sam had filled the prescription for antidepressants the day after he busted Dean from detox, same as he'd filled all the others, but Dean still hasn't touched them. He's taking everything else, thank Christ, because not a day goes by the Sam doesn't think about the seizures the doctor told him about in the waiting room at the hospital, and even though they're "unlikely to return" now that Dean isn't on the drug that caused them, he's not sure he could deal with Dean losing control like that.

"I'm going to get back on the hunt once we hit that one you found in Georgia," Dean says as he's watching television in a steamy hotel room in southern Pennsylvania. Sam had brought him a takeout carton of sweet and sour chicken, but it's sitting untouched on the bedside table, and Dean is moving tenderly, like his stomach is hurting him again.

There isn't a hunt in Georgia, and Sam's glad there isn't. But at least Dean hasn't set a definite deadline for himself. Usually he'll start getting antsy and give himself a certain amount of time before he just isn't allowed to not be on his feet, but "whenever we hit Georgia" is nebulous enough that Dean must not feel very good. "How about you eat some of that chicken and we'll talk hunting."

Dean flashes him an annoyed expression and gets up, still wrapped in a blanket. "How about you leave me alone about it already," he says. He slams the bathroom door, but the trailing blanket stops it from closing all the way, and he hears the shower turn on, and then he hears Dean vomiting. He runs a hand through his hair and debates with himself for a minute before he loses the argument with himself and charges in.

It's not like Dean has bunches of hair that he can hold back in the cliché way of fiction, so Sam settles for rubbing awkwardly at his back, and in the process he notices that he can feel every knob of Dean's spine in intimate detail through three layers of cloth. When Dean has finished dry-heaving, Sam jerks him back from the toilet, spins him around, and unzips the hoodie that he'd taken to wearing over everything else. Dean just has a dazed expression, and he's trailing a rope of saliva, but he must know what Sam is after. The layers have hidden it, but Dean has probably _lost_ weight since he left the hospital. He's one missed meal away from starving-dog territory.

"_Jesus_, Dean!"

"Lemme 'lone, Sammy."

"You didn't think to tell me that you were wasting away? That you were vomiting up everything you managed to eat?" His rucked up t-shirt reveals jutting hipbones and a concave belly. It's among of the most terrifying things Sam has ever seen.

"Are we…are we ever going to talk about this?"

"Leave it _alone_, Sam."

"You're –."

"I said I'm done!"

And he storms out of the room, back into his bed, face turned decisively toward the wall.

Sam checks Dean's pill bottles to make sure that he's taking everything, and sure enough, his anti-nausea meds are slowly disappearing with the rest of them; only the antidepressants remain untouched. And then Sam has to leave the hotel to cool down, both literally and figuratively. That first step outside is like stepping straight from a rainforest into an arctic tundra. He makes the decision then and there that it's time to give up on trying to feed his brother anything relatively healthy and start just getting calories in him. It's nearly nine on a Wednesday in Podunk Pennsylvania, and he's wondering if there's anywhere in the area that will serve him pie.

It occurs to him as he's pulling out of the parking lot, jutting hipbones fresh in his mind, that maybe Dean is so far gone that rich, solid foods are too much for him to handle.

Liquefied pie, he amends, and drives cautiously into the snow.

* * *

Sam starts buying milkshakes; Dean stops locking himself in the bathroom with the shower running every other hour. But he also stops sleeping. Used to be, for the first week maybe, that was all he could do, all he could think of doing, but anymore Sam will wake in the middle of the night to find him watching infomercials on mute, his eyes glazed, his whole body trembling beneath the blankets.

His self-restraint goes with his sleeping habits, and he starts asking for a drink at least once a day. It seems to genuinely startle him after Sam says no, too. Like he's forgotten what landed him in this fucked up situation in the first place. If Sam were stupid enough to leave alcohol lying around, or if Dean felt well enough to go out looking for, Sam might actually be concerned about Dean breaking the whole thing off.

He says its all nothing in a typical Dean fashion, still yammering about the hunt down in Georgia, doesn't even seem to realize that they haven't moved all that far past Pennsylvania because even though it's cold as hell up here, Dean's having a hard time sitting in the passenger seat of the Impala for long stretches.

Dean's not himself. Hasn't been since Sam picked him up, but when he'd been sleeping, he'd at least had the energy to crack jokes at his own expense. Now he just doesn't, and Sam is driving himself crazy trying to get some ice cream down his throat. But things are moving so steadily downwards, things are in such a decline, and there's usually a point in the Winchesters' lives where things just _crack_, and things get so bad they can't possibly get worse, and then – _then, _when Sam and Dean have hit rock bottom, they are free to find a solution. He'd thought rock bottom had been Dean in that first hotel room, weeks and week ago, shouting and waving a knife at something that only he could see. But now he's left waiting for something i_worse_.

So it almost comes as a relief when, about three weeks after his initial release, Dean has a seizure just outside of Richmond, Virginia.

No, it's not a relief; it's one of the most horrible things he's ever seen. One second, Dean is up and on his way to the bathroom, the next he's twitching on the ground, panting, making weird choking noises, completely unaware. Sam hooks him by the shoulders, watches helplessly as he pisses himself and his muscles go so, so tight. He puts him on his side and debates about calling for an ambulance, because between his brother and his father Sam has been responsible for cleaning up some pretty atrocious medical maladies, though he's never had to deal with a seizure before. Somehow he keeps it together, somehow he manages to not call 911, because he knows what this is, and he _is definitely, definitely in control, goddamnit._

When he's finished seizing, Dean is confused and disoriented and floppy – but he's easy enough to manipulate into the Impala and take to the ER.

They ask Sam how long the seizure lasted – he doesn't know. They strip off Dean's hoodies as he murmurs confusedly, just starting to come back to himself, like his brain is rebooting one neuron at a time. When they see the prominent bones, Sam feels just as guilty as their incriminating expressions seem to imply he should, and he feels more guilty than ever when he tells them the situation and they balk at the fact that he let his brother get away with not going to rehab.

There's no lasting damage, it's unlikely to happen again if he takes his new medications correctly, and they can only hold his stubborn brother so long as he is willing to be held. Dean gets really tired after he's come back to himself though, and now he's dozing away the muscle aches in a hospital bed in an open ward.

As he's sitting by Dean's side, knowing his time is short, he thinks about that phone call in the cemetery and about the antidepressants sitting untouched in Dean's duffle, and he asks the nurse if there's maybe someone he can talk to.

* * *

"Sam Roth, right? Your brother is the recovering alcoholic."

Sam flinches _hard_ at the word, because _hell_. "He's – ah. He's not."

She blinks at him. She's pretty – bookish pretty, with horn-rimmed glasses and a burgundy smile. Her office is full of light and smells like flowers. Sam feels outrageously out of place. "An alcoholic? Mr. Roth, you of all people must realize."

"He did what he had to do to cope, Ms. –"

"Call me Susan. And cope with what, Mr. Roth?"

"Sam."

"Sam."

"He's had – a lot going on. For a long time."

"Even so. You sought treatment for his detoxification. Why do so if you do not consider him an alcoholic?"

Because it had started to get in the way of the hunt. Because Dean had been trapped under a pile of rubble for nearly twelve hours as Sam rushed to excavate him, and he'd come out delirious and shaking and frantic for a drink. They hadn't been able to finish the spirit, and it had killed again – a husband, a father. Dean had been so pissed off that he'd broken a fifth of whiskey against the hotel room wall, and then he'd been even more pissed when he'd had to go out to buy more.

Sam shrugs. "He just drinks a lot. That's all. He needed to stop drinking quite so much, and now he has."

"You said he's had a lot going on."

"Yeah."

"And that's the reason that he drinks."

"Yeah, I guess."

"Has your brother seen a counselor, been to a rehab facility? Is he taking antidepressants?"

Sam shakes his head.

"Then, Sam, forgive me, but – how does it make sense to just treat the symptoms of a larger, more systemic problem?"

And that's it. That's all. They're just sitting in a salt circle. They haven't even tried to burn the freaking bones.

* * *

When Dean comes to, Sam thrusts an antidepressant in his face. "If you won't go to rehab, you have to at least try to take this."

"What? What is that? Is that –" he squinches his face at the pill until it seems to dawn on him. "Is that the fuckin' antidepressant?" he asks sleepily. "No. No way."

"Yes, yes way, yes Dean."

"I just had a goddamn seizure, Sammy, cut me a break."

"No. Take it."

"What's the fuckin' point?"

"The _point_, Dean, is that our lives _suck_, and they're not going to get better, and you were self-medicating with alcohol, and you have to start medicating with something else now that that's gone, or I'm going to _lose_ you."

"I wasn't _self-medicating_ –"

"_You're an alcoholic!_" They're still in an open ward. Sam has spoken too loudly, and one of the nurses, the one that had looked at Sam like some kind of flesh-eating virus earlier when she'd seen Dean's jutting ribcage, glares at him over the top of some machines. On the monitor to his left, Dean's heart-rate spikes. Quieter this time, he says, "You're an alcoholic. You haven't had a drink in a while, but you're still an alcoholic, and until we talk about it, or – or you…do something about it, or you – _acknowledge it. _Dean, I don't think it's gonna go away."

Dean won't talk. Dean will never talk, that's just _Dean_. And maybe that's a step that they're not ready to take yet, or ever. But this is a compromise, and Dean will recognize it when he sees it. Don't talk, fine, don't change anything. But take the pill, and admit you have a problem, and be one step above what our dad always expected of you. It's not weak to show weakness, Dean.

"Hell," Dean murmurs. "Like a freakin' _girl_." Dean doesn't specify who the "freakin' girl" is. Sam suspects it's both of them. But miracle of all miracles – Dean takes the fucking pill.

* * *

Things don't get better immediately. Dean seems to want to quit when he doesn't feel like sunshine and roses after the first week, but Sam gives him all his pills religiously. He's supervising now, not trusting Dean not to renege on his show of self-proclaimed weakness.

After they leave the hospital, both of them are scared that Dean is, despite his new medications, going to have another seizure. He walks without lifting his feet, sometimes, and spends a lot of his life in bed not sleeping. Dean doesn't like that something happened to his body that he had so little control over, Sam knows, and it drives him crazy that it could happen again and he couldn't lift a finger to stop it. He's scared. He's also irritable, and his stomach's still upset, and one day, as Sam is helping him into the bathroom, he stumbles on his own over-careful feet and then he busts out i_crying_.

They're both so startled that they nervously laugh their way through another bout of dry-heaving.

"Hey, darlin'," Dean charms the waitress at a Cheesecake Factory in North Carolina. Sam can think of nothing better for Dean than the amount of calories this place packs into every meal, and Dean had said that as long as he was only able to keep milkshakes down, he might as well eat them in style. "I'll have a milkshake to start. Big, tall, 'n fancy."

The girl is young and suitably charmed, and she asks, "You want that spiked? The Flying Gorilla has a splash of –"

Dean swallows hard, and Sam should have thought of this. Until now he'd avoided restaurants with liquor licenses like the plague, but Cheesecake Factory was so big and chain-y he'd forgotten. He's about to panic and jump in and refuse for his brother, but Dean surprises him by refusing himself.

"No, no, I'd have to make my peace with Jesus if I drank one of those Flying Gorillas. Recovering alcoholic, you know?" Sam looks at his brother like a crazy person until he sees that the girl has an Alcoholics Anonymous one year coin on a chain around her neck, and holy hell, his brother is _flirting._

She gives him shining eyes of admiration, gushes about the coin around her neck, and tells Dean how _proud_ of him she is when he tells her that he's been at it for just a few months now.

His brother also just referred to himself as an alcoholic, and it's the first time he's ever done that. Ever. He drinks a whole alcohol-free milkshake, he gets the waitresses' number, and he vigorously ruffles Sam's hair as their walking out the door.

And, okay, yeah, maybe Sam is a little proud of him, too.

* * *

A month after he's started on the anti-depressants, a month in which Dean thankfully, thankfully doesn't have another seizure, and Dean really starts holding onto the weight he's lost. Once he does, it's kind of remarkable how much better he seems to feel. He still gets bouts of nausea, but he actually has an appetite, now. He craves foods, he wants cheeseburgers and tacos and dumplings, and Sam is more than happy to fetch them for him.

They've been slowly meandering their way down the east coast for two months, and when they do hit Georgia, the land of the promised hunt from their first few weeks back on the road, Dean's sharp edges have rounded out a bit. And maybe he's not the hale and hearty weight he was when Cas first brought him back, but he's not shivering all the time anymore. It might have something to do with the dawning spring, but more likely, it's the meat on his bones, it's every hard-earned ounce.

They take a simple salt and burn when Dean starts to get antsy, and he does need to start building up some of the muscles he's lost, so they take turns digging the grave. Sam does most of it, and Dean talks. And talks, and talks like he hasn't in a while.

"—And I think. You know. The uh – the pills."

"The antidepressants," Sam says, and scoops a shovelful of dirt over the edge of the grave.

"Yeah. Those. I mean. They're helping."

Sam doesn't pause in his digging, doesn't look at Dean, hardly dares to breathe. He just says, "Good."

"And you know, Sammy. Uh. It's not..." Pause.

"…Dean, we don't have to talk about it. I get that you don't want to. I just want you to keep taking the pills."

"No Sammy it's just – it's not fair. To you. Because it's not your fault."

Sam hits the coffin with a dull thunk.

"What?"

"Stop. Blaming yourself. For me being a goddamn alcoholic. For me being – a skinny fuckin' girl. S'my job, anyway. Guilt tripping."

Sam looks up at him and says, "I wasn't –" Until he realizes, okay. Yeah. He was. He really, really was.

They're silent for a moment.

"Now are we gonna light this sucker up, or what?"

He lets Dean pour the lighter fluid and start the fire, even though he did most of the digging work. And in the harsh light of the grave fire, his cheekbones don't stand out half so much as they had, hell, even six months ago.

"Sorry. Sorry, Sammy," Dean whispers.

"S'ok, Dean."

Dean will probably stop taking the antidepressants after the first full course, because they haven't got a prescription for a refill and Dean definitely won't go to get another.

But that's alright. They'll find another way to keep it together. They always do.


End file.
